Father of cardiac surgery in india

174 © 2018 Annals of Pediatric Cardiology | Published by Wolters Kluwer ‑ Medknow
Address for correspondence: Prof. Rao R Ivatury, 3010 Newquay Lane, Richmond, VA 23236, USA. E‑mail: raoivatury@gmail.com
INTRODUCTION
Congenital heart defects (CHDs), the most common
form of birth anomalies, affect about 1% of live births
according to the American Heart Association. Of the
180,000 children born with CHD each year in India,
nearly 60,000–90,000 suffer from critical lesions
requiring early intervention.[1]
Congenital and neonatal
surgery has become commonplace in the major centers
around the world, as well as in India with excellent
results.[1‑5]
From humble beginnings, the art and science
of this complex surgery in India was carried forward on
the shoulders of giants in all of its aspects.[1,2,5,6‑10]
Professor IM Rao [Figure 1] from All India Institute of
Medical Sciences (AIIMS), New Delhi belonged to this
elite, small group. His 25 years in that institution were
a tale of tumultuous travails and tribulations but also
triumphs in the evolution of congenital and neonatal
cardiac surgery. The objective of this report is to
document for history his brilliant contributions to the
field.
Ivatury Mrityunjaya Rao (IM Rao, as he was called in later
professional life, to avoid the tongue‑twisting first name)
was born in the town of Kakinada in Andhra Pradesh,
a coastal state in South India. His father, I. Joga Rao,
was a very renowned physician and surgeon in the
district capital town, his reputation often crossing the
boundaries of adjacent districts, even states. Under his
profound influence of hard work ethic and brilliance,
IM Rao blossomed into a very accomplished and bright
young man. Most of his success, however, had to do
with his brilliant mind and outstanding memory and
much less due to hard work! His medical school career in
Andhra Medical College (AMC), one of the oldest medical
schools in the country, was exemplary. He received
many accolades and gold medals and graduated with
top honors. In medical school, he had the additional
honor of courting and marrying his wife, Dr. Meera, a
colleague in AMC. A strong personality, Meera would
prove to be a tremendous asset in his life. IM Rao had
always known he would be a surgeon, having caught the
excitement while watching and at times participating in
his father’s surgical procedures. He went on to complete
with honors his postgraduate studies in AMC, for the
degree of Master of Surgery.
The young surgeon happened to stumble on a book
called “The Operation,” describing a day in the life of
Walton Lillihei, the pioneering cardiac surgeon from
Minnesota.[11]
He was captivated by the inventions in
cross‑circulation and open‑heart surgery, and he became
more and more passionate about cardiac surgery as his
Developing congenital heart surgery in India: The travails and triumphs
of a pioneer
Rao R Ivatury
Department of Surgery, VCU Medical Center, Richmond, VA, USA
ABSTRACT
Professor IM Rao, from All India Institute of Medical Sciences, New Delhi, was a pioneering cardiac surgeon
who, against overwhelming odds, developed congenital heart surgery in India. He made many contributions
to the evolution of his specialty, spanning more than four decades and three countries. This is a brief report of
his professional life and accomplishments.
Keywords: Congenital heart disease, neonatal cardiac surgery, pediatric cardiac surgery
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Ivatury: Pioneering congenital heart surgery in India
175Annals of Pediatric Cardiology / Volume 11 / Issue 2 / May-August 2018
It is small wonder that IM Rao chose AIIMS for his M.Ch
training in cardiothoracic surgery under Professor
Gopinath.
Early Open Heart Surgery (1964–1971) at AIIMS was
primitive: Use of reusable large‑prime disc oxygenator
with a lot of bleeding problems, cumbersome recorders,
reusable transducers and 3‑way stop‑cocks. In 1968, IM
Rao and his colleague M. Girinath visited Dr. Stanley
John at CMC in Vellore. Professor John had been
producing excellent results in mitral valve surgery,
VSD, and Tetralogy of Fallot (TOF) and boasted of the
largest reported series[5]
with a cohort of 300 adults
aged >14 years utilizing the transventricular route. The
AIIMS doctors brought back ideas and techniques.
IM Rao finished his training as a Registrar in 1969 and
obtained his M.Ch. He then joined the faculty of AIIMS in
1970, a position he would occupy for the next 25 years.
IM Rao’s passion for pediatric cardiac surgery started
to blossom. Conditions were steadily advancing at the
AIIMS: initially, Travenol bag, then Ryg bag oxygenators
were used for surgery performed on older children
and young adults for CHD. IM Rao was enthused and
mesmerized by Professor Raj Tandon, a brilliant Pediatric
Cardiologist. He also had a partner in Dr. Venugopal, who
underwent training abroad with Professor Denton Cooley
in Texas and with Dr. Subramanian in Buffalo. The duo
made significant advances: switch from Polystan bag to
Shiley Bubble Oxygenator, introduction of disposable
cannuale with tubing and Bjork‑Shiley Valves. There was
a gratifying improvement in results.
The next landmark event occurred in 1973. IM Rao went
on to work at Green Lane Hospital, Auckland, New Zealand
under the legend, Sir Brian Barratt‑Boyes, along with
his team from AIIMS: Dr. Rajani (Radiology) and
Dr. Punnose (Anesthesia). Very few places in the world
were doing infant cardiac surgery at this time and Sir
Barratt‑Boyes had a great team of pediatric cardiologists,
radiologists, pathologists, and anesthesiologists. He was
a gifted surgeon, a great intellect and was a protégé of
Dr. John Kirklin. He was very eminent in all areas of
surgery: homograft aortic valves as well as infant cardiac
surgery.[12]
IM Rao was one of his seven registrars. Others,
of note, were Dr. Roger Mee from Australia (who would
feature prominently in IM Rao’s career in subsequent
years), and Dr. K.M. Cherian from Chennai, India (who
would become a legend in his own right in South India).
This fellowship cemented IM Rao’s passion for congenital
and neonatal pediatric cardiac surgery. Declining Sir
Boyes’s invitation to join his team, he headed back to
AIIMS in 1975.
Back in New Delhi, IM Rao found infant cardiac
surgery very hard to establish. Referrals were very
few, since pediatric cardiologists had a misguided
faith in spontaneous closure of congenital lesions. The
calling. Lillehei’s attempts at open heart surgery with
cardiopulmonary bypass, the experiments of Lillehei and
his group on cross‑circulation in dogs (a big dog serving
as an oxygenator for a small dog), the subsequent trial in
humans in March of 1954, and the invention of Bubble
Oxygenator were inspiring stories for the young surgeon.
IM Rao learned that across the world, in India too, those
were heady days for the specialty of cardiothoracic
surgery. The 50s and 60s saw many landmark
contributions from Indian scientists:[1‑5]
Potts‑Smith
shunt for cyanotic heart disease in 1951, Pericardiectomy
for constrictive pericarditis in 1952, and pulmonary
valvotomy under inflow occlusion in 1953 by Professor
Betts and his team at Vellore; the first successful
closed digital mitral valvotomy (1952), repair of
coarctation of the aorta in 1953, and closure of a atrial
septal defect (ASD) in 1954 under surface‑induced
hypothermia at the K.E.M. Hospital, Bombay, by Doctor
P.K. Sen. 1961 saw K.N. Dastur utilizing a disc oxygenator
for ASD closure.
In May 1961, Dr. N. Gopinath of the Christian Medical
College (CMC) Hospital, Vellore, closed a ventricular
septal defect (VSD) in the first open‑heart surgery in
India. Dr. Gopinath already had had a distinguished
career by then. He was the first Indian to be awarded a
postgraduate (Postdoctoral) degree in Thoracic Surgery
by the University of Madras – the first university in India
to do so. After a fellowship with Dr. Lillehei from 1957
to 1958, he succeeded Dr. Betts in 1960 as the Head of
Cardiothoracic unit at CMC.
In April of 1964, Professor Gopinath moved to the AIIMS,
even though the facilities were very limited: One shared
operation theater and a four‑bedded postoperative ward.
Professor Gopinath set about improving these conditions
and aspiring for a separate cardiac center one day. He
made significant advances and was recognized as a great
surgeon, a great teacher, and an extraordinary mentor.
Figure 1: Prof. Ivatury Mrityunjaya Rao

176 Annals of Pediatric Cardiology / Volume 11 / Issue 2 / May-August 2018
Green Lane technique of deep hypothermic circulatory
arrest (DHCA) was difficult and cumbersome to reproduce.
Politics, as wont to happen in a developing center, was
rearing its ugly head. There was very little support for
creating a separate pediatric and neonatal cardiac team
or pediatric‑specific techniques. Adult cardiac surgeons
were piling up a large number of coronary operations,
but there was very little enthusiasm for developing
the same momentum for pediatric conditions. Such
was the put‑down that an adult CT surgeon was heard
to comment: “what a waste of money!” when a pulse
oximeter was bought for a pediatric patient! Neither the
sick infants nor the postgraduate fellows interested in
their surgery were getting any attention.
Other handicaps and obstacles soon became evident:
The so‑called ICU consisted of 1–2 beds with the surgeon
and an anesthesiologist bagging the infants with an
Ambu‑bag, guessing at the optimal tidal volumes.
Arterial blood gasses’ laboratory was a building and
an hour away. There were no good volume‑cycled
ventilators, compressed air and blenders, warmers, or
incubators. Ventilation protocols and safe‑extubation
techniques were nonexistent. There were no inotropes
and vasodilators. It was the sheer courage and dedication
of the surgeon and his paltry team that kept many infants
alive, even when mortality was high.
Despite these odds, over the next 5 years (1975–1980),
IM Rao worked diligently to bring modern concepts of
perfusion protocols, de‑airing and selective coronary
perfusion. There was an improvement of results of valve
replacements because of safer techniques. Cardioplegia,
however, could not be reproduced. Furthermore, difficult
to achieve were reusable external heat exchanger and
Blood Cardioplegia Delivery, major hypothermia, and
circulatory arrest in small infants.
In 1977, IM Rao visited Dr. K.M. Cherian in Chennai
(Madras). As noted above, the two were co‑fellows
in Auckland. On his return to the Railway Hospital
in Perambur, Madras, Dr. Cherian and his team of
Australians from Sydney performed cases with DHCA
and opened up the vista for infant cardiac surgery in
India. IM Rao brought further fresh ideas and techniques
back to the AIIMS.
A huge calamitous adversity, unfortunately, was awaiting
IM Rao. He had just returned from Milwaukee, Wisconsin
in 1984, where he spent almost a year as a fellow.
Persistent back pain following a bout of pneumonia was
labeled “osteochondritis” initially but finally lead to a
diagnosis of paraspinal abscess from tuberculosis of the
spine in 1986. He underwent surgery, was hospitalized,
and was out of his surgical practice for almost a year.
He was on bed for 6 months and on anti‑tuberculous
treatment. Only in early 1987, he recommenced going
to the O.T, initially as an observer in a back brace.
Meanwhile, the Cardiac and Neuro Center of AIIMS
was finally opened in 1986 with Professor Venugopal
at the helm (Professor Gopinath had retired in 1983).
A separate pediatric section, however, did not receive
any support.
It was June of 1987. Dr. Shrivatsava, a pediatric
cardiologist, had a 2‑month‑old infant with a
rhabdomyoma of the heart. She referred the case to
IM Rao for surgery. The operation was a remarkable
success. IM Rao used it to brilliantly showcase principles
of congenital heart surgery[13]
including DHCA and
perfusion. Suddenly, the fate of IM Rao and pediatric
cardiac surgery at AIIMS was transformed. The pediatric
service picked up momentum.
In those pioneering days, IM Rao was fortunate to be
joined by Dr. Krishna Iyer as a registrar. Dr. Iyer was
brilliant, motivated, hardworking and the two made
a highly competent and successful team, becoming
the architects of congenital and neonatal cardiac
surgery in India. Dr. Iyer would go on to become the
most accomplished pediatric cardiac surgeon in India,
initiating the first dedicated pediatric cardiac care
program in Northern India in 1995 at (now Fortis‑Escorts
Heart Institute). Joined by other bright registrars such as
Drs. Airan, Murthy, and Krishnan, the congenital heart
team at the AIIMS, were soon turning out remarkable
successes in TOF, early Kreutzer operation for Tricuspid
Atresia, and the “Senning” operation for Transposition
og Great Arteries (TGA). IM Rao and his team established
protocols of infant perfusion: cardioplegia with syringe,
limitation of Total Cardiac Arrest (TCA) as regards time
allowed for repair leading to direct bicaval cannulation,
hypothermia, and low flow bypass using Polystan and
Pacifico cannulas (IM Rao had borrowed Pacificos from
Dr. Cherian during his visits).
In August and September of 1988, IM Rao visited the
Royal Children Hospital, Melbourne, Australia as a visiting
Professor for 3 weeks with Roger Mee, his colleague at
Green Lane Hospital. The visit gave a good perspective
of modern pediatric cardiac surgical practices. There
he learned about transatrial repair of TOF and arterial
switch operation (ASO) for TGA in a neonate. Dr. Mee
was a guide and an inspiration. He would visit IM Rao
and his team on several occasions. He would also train
Doctors Iyer and Parvathi Iyer from IM Rao’s team.
Doctors Iyer and IM Rao began to see the budding
success of CHD surgery at AIIMS. Around the same time,
Dr. Rajesh Sharma returned after training at Boston
Children’s Hospital, and this further boosted the section.
At this time, transventricular correction of TOF was
commonplace. Good results were seen with primary
infundibular patches and VSD closure. However,
residual defects and difficulties with transannular patch

cases with a high incidence of length of stay following
correction were a frequent problem. It was during this
period that the TOF repair had a new modification
introduced by IM Rao and his associates for the first
time in India: the transatrial repair of TOF that he had
learned in Melbourne. The improvement in results was
impressive.[14]
Spectators of IM Rao’s transatrial repair
soon hailed it as a “virtuoso performance” (Dr. Paranzan
from Italy). Now, IM Rao jokes about it: “We have
energetically championed this technique: Like a recent
convert, more catholic than the Pope.” Transatrial
correction of TOF is now the most commonly used
technique in India.
IM Rao and his team continued to record other
successes.[15‑20]
Neonates with TGA were diagnosed by
Echo and referred for ASO by Dr. Srivastava. The first
cases were without preoperative BAS. Heparinized fresh
blood was used in the prime. While Dr KS Cherian was
doing ASO in older Children with VSD, neonatal ASO
was only being done by IM Rao in AIIMS. He learned the
techniques of Coronary Buttons Trap Door from Roger
Mee and Coronary Buttons into Root (Pacifico) with better
sutures and blood products.
In 1992, IM Rao got his green card for immigration to the
USA. He visited the Mayo Clinic, Columbia‑Presbyterian
in New York and Boston Children’s in 1993. There he
received an invitation form the legendary Albert Starr
from Portland, Oregon to be a visiting professor. He was
thrilled to see the accurate, simple techniques of repair
of Dr. Starr, who was equally adept at valve, coronary,
and complex neonatal surgery. He also learned the policy
of verifying the success of the operation with immediate
postoperative, on‑table transesophageal ECHO, a practice
he would soon popularize as a dictum in congenital
cardiac surgery.
Thus ended the first quarter‑century of IM Rao’s
tumultuous journey into congenital and neonatal cardiac
surgery.
In the superb story of Roger Mee and his career in
neonatal surgery called “Walk on Water” by Mark
Ruhlman,[10]
Mee comments on the rigors and personal
sacrifice that this career demands: “he (the peds heart
surgeon) had to make judgements…… fast and act
decisively, and he had to be right.” And…. “You can’t hide
when you’re a peds heart surgeon.….Because the stakes
are so high, because there is so much at risk, there is no
room for dishonesty…….You can’t lie to yourself here,
because if you lie to yourself, it becomes very obvious.
Somebody dies.”
Perhaps it was this stress. Perhaps it was the constant and
brutal self‑assessment and appraisal, with feelings of guilt
and inadequacy. Perhaps it was a deep character blemish
in a susceptible personality. Perhaps it was a toxic mix
of all of these, magnified by the harrowing demands of
complex heart surgery, and the constant struggle with
detestably weak administrative support. It will never be
clear. What is certain was the toll it took on IM Rao. His
near‑disastrous episodes of alcohol and nicotine excess
threatened to destroy him, his marriage, and his career.
Fortunately for him, he was rescued by his passionate
love of pediatric cardiac surgery and the incredible
support given by his circle of family, especially his wife
Meera, his friends, and students. Very reminiscent of a
similar but more benign fight: the reported struggle of
both Roger Mee and his mentor, Sir Brian Barrett‑Boyes
with their addiction to smoking.[10,11]
In his tenure at AIIMS, IM Rao mentored many young
surgeons in surgery as well as congenital heart surgery.
He would be kind, gracious, accommodating, inspiring,
encouraging, and also critical as necessary. All who
worked with him called him a true gentleman, a master
teacher, and a master craftsman. One commented “when
he is operating his hands are conducting an orchestra.”
He would scrub with juniors and share with them critical
parts of the operation and teach the intricacies of his
craft. He was always willing to give them a chance to
express themselves, at times at his own expense! In return,
they admired his style (some called it “swash‑buckling”)
and confidence. They adored his honesty, his humility,
friendliness, and mentorship. They loved his guidance
and quiet benevolence and empathy to young trainees.
Many of them gave him moral and political support,
albeit silently, not to upset the powers‑to‑be. A testament
to his mentorship: the majority of his registrars (about
45 during his tenure) became leaders in the specialty
of congenital cardiac surgery all over the country and
abroad. Prominent examples include Dr. Krishna Iyer;
head of the Department of Paediatric and Congenital
Heart Surgery, Escorts Heart Institute in New Delhi;
Dr. Mohan Reddy, Chief of pediatric cardiac surgery
in University of California at San Francisco; Dr. Balram
Airan, immediate past Chair of the Department of
Cardio Thoracic Surgery at AIIMS; Dr. Anil Kumar
Dharmapuram, now at KIMS, Hyderabad.
It was at the behest of one of his mentees, Dr. Nazer that
the next chapter in IM Rao’s saga with neonatal cardiac
surgery sprouted in a different country. IM Rao made
a lasting impression on Nazer when he was a fellow at
AIIMS. The two spent some time together in Sydney. In
1995, as IM Rao was finishing his visit with Professor
Starr, Nazer was the head of the Cardio Thoracic Surgery
unit at Al Mafraq hospital in Abu Dhabi, UAE. He invited
IM Rao to set up a congenital heart surgery service.
Despite some disparaging and maligning remarks from
AIIMS “bigwigs,” IM Rao succeeded in getting a position
as a “locum” for about 3 months with Nazer’s help. The
“locum” position would last for more than a decade.
Nazer would become his friend, guide, and philosopher.

NEONATAL SURGERY IN UAE (1995–2007)
UAE has a population of about 3 million and was blessed
with an excellent infrastructure and health care. Infants
born with heart defects were referred to Al Mafraq
Hospital in Abu Dhabi for diagnosis and treatment. The
transport facilities for the neonate were excellent. The
neonatal unit was set up by Professor Brom and headed
by Dr. Sadhegatian. IM Rao and his team had a chance to
see every infant with CHD and the team of cardiologists
and surgeons would conjointly plan the treatment.
Soon after his arrival, IM Rao gained the confidence of
the Arabic administrators by his professional attitude
and pleasant personality. Recognizing the fatal nature
of mistakes, IM Rao concentrated on the minutest
details: transport, anesthesia, diagnosis, perfusion,
suture materials, etc., The operative steps were set
in stone with no deviation from the established
routine. Besides Nazer, IM Rao had good support
from the pediatric cardiology team headed by Prof.
Venkitachalam and Dr. Suresh Kumar. The anesthesia
team, consisting of Drs. Dhir, Saxenna, and Sivan, was
strong and excellent. Dr. Anil Kumar Dharmapuram, a
former fellow of IM Rao at AIIMS, was a personal and
professional friend, besides being a partner. A new era
of neonatal pediatric cardiac surgery was born in the
UAE with this able team.
Reproducible surgical techniques learned from other
countries were soon planted at Mafraq. New concepts
of ameliorating bypass tissue reaction by using Trasylol,
improved perfusion methods, CO2
in pump, superior
cardioplegia techniques, use of phenoxybenzamine, etc.,
were standardized. The multinational team of Mafraq
unit started to produce large series of CHD operations
with ever‑improving results. Mortality rates for high‑risk
procedures came steadily down. As an example, the
second set of fifty patients with ASO had successful
correction with zero mortality. In a short time, Mafraq
became widely popular in the UAE as the go‑to place
for neonatal, pediatric, and adult cardiac surgery from
near‑by middle‑east countries. IM Rao recollects one
eventful week when they did ASO on three infants of
different nationalities successfully. The unit at Mafraq
was regularly attracting international dignitaries in
congenital heart surgery: professors Gopinath (AIIMS),
Lacour‑Gayet (Paris), Sabiston (Duke University),
Loop (Cleveland Clinic), de Leval (GOS, London),
Iyer (Fortis, New Delhi), and Airan (AIIMS). Everyone was
stunned at the quality of the work of the pediatric cardiac
surgery team. In view of the excellent work and results,
the General Authority of Health Services appreciated the
Department by giving the first Sheikh Hamdan award
for clinical excellence in the year 2003. The long‑eluded
sense of personal achievement and happiness was finally
in IM Rao’s grasp.
One of the pioneers and stalwarts of cardiothoracic
surgery in India was Dr. C.S. Sadasivan.[21]
He was from
AMC, the same medical school that IM Rao attended.
A brilliant scholar, he had training abroad from great
pioneers such as Sir. Russel Brock, Andrew Logan,
Professors Crawford, and Dubost. Dr. Sadasivan was
passionate about making India self‑sufficient in all
aspects of cardiothoracic surgery. He received many
accolades and honors, one of them the Padma Shri in
1969, one of the highest honors in India. In his honor,
The Indian Association for Thoracic and Cardio‑Vascular
Surgery (IATCVS) had initiated an annual Sadasivan
memorial oration at its annual meeting in 1981. The first
orator was none other than IM Rao’s mentor Professor
Gopinath. Many past presidents of the association were
Sadasivan orators.
The call came in 2002. IM Rao was invited to give
the Sadasivan oration in the annual conference
of the Society in 2003, the highest honor given out
by the Association: a sweet vindication of his success in
establishing congenital cardiac surgery. As is repeated
in history so often, he had to go out of his own country
to get due recognition. In February 2003, IM Rao
delivered the Sadasivan oration. His topic: “Challenge
of the Neonate: A Cardiac Surgeon’s perspective.”
In his talk, he reviewed common congenital cardiac
deformities, their surgical correction, principles
of DHCA, protocols of perfusion, maintenance of
homeostasis, and the science of cardioplegia. He
emphasized intra‑ and post‑operative care, metabolic
support of the infant, and abatement of inflammatory
response to the “plege” and surgery. He elegantly
described the ASO (“conceptually the most brilliant
and ‘simple’ operation”) and detailed the process of
coronary transfer (“Good thing the coronaries are
the sensible ones,” in the words of Mee). He backed
up his theoretical concepts with his results from
Mafraq (1997–2002). He then went on to demonstrate
his technique by showing a video of ASO in TGA IVS
in a 20‑day neonate. It was a masterful presentation,
according to some of his peers in the audience. So was
his summation quote from W. J. Potts: A Neonate’s
Prayer: “Give me good oxygenation and do good repair,
I will surprise you how well and how quickly I heal!”
Important contributions of the Mafraq group
continued.[22‑25]
In 2002, Drs. Anil Kumar Dharmapuram
and IM Rao pioneered single‑patch technique of A_V
canal septal defect in 15 infants.[24]
In 2003, they
reported on 48 consecutive neonates who underwent
systemic to pulmonary arterial shunts for cyanosis with
reduced pulmonary blood flow, concluding that these
shunts in neonates are a gratifying and reasonably safe
surgical procedure, before eventual univentricular/
biventricular repair.[25]

By 2007, the political winds whipped up again and for
their own reasons, the Ministry of Health at Abu Dhabi
decided to close the cardiac surgery services. It was
time for IM Rao to go home, but not before he showed
everyone what a team effort can accomplish “with a
li’lle help from friends.” He inspired and showed his
colleagues and peers how to lead. Nazer proudly and
fondly reflects on the great privilege they all had shared:
providing totally free cardiac surgical services of very
high quality to all nationalities in the world, a privilege
not many surgeons can boast of.
“No place for prima donnas!” and “Come on Man! This
is not rocket science!” were IM Rao’s famous words. He
left Abu Dhabi in 2008, but not before he had survived
a coronary artery blockage that required angioplasty by
one of his own teammates.
HYDERABAD, INDIA (JUNE 2008)
IM Rao returned to Hyderabad in his own state of
Andhra Pradesh as the Dean (Academic and Research) in
Innova Children’s Heart Hospital. He was with his former
fellows Doctors Anil Kumar and S. Murthy, enjoying his
position as a consultant for congenital heart surgery.
In Andhra Pradesh, the State Government had set up the
Aarogyasri Health Care Trust under the chairmanship of
the Chief Minister. The beneficiaries of the scheme were
the members of below poverty line families with the goal
to improve their access to quality medical care, through
an identified network of health‑care providers. The
scheme had a phenomenal impact and Innova Hospital
piled up huge numbers of cases under the scheme. The
experience also signified the large prevalence of CHD
lesions in the population.
IM Rao’s keynote address: “In search of Mentors in a land
of over billion people” at the 12th
Annual Conference of
the Paediatric Cardiac Society of India in 2010 at Mumbai
was a well‑received oration, replete with quotations from
Hindu Sanskrit literature. In April 2013, he moved on to
become the Clinical Director of pediatric cardiac services,
KIMS Hospitals, Secunderabad. His retirement was not
uneventful. He had a CABG performed in 2008 at Mumbai
by one of his students and had several hospitalizations
for other health issues. Despite his illness, he and his
colleagues made several contributions to the surgical
literature on CHD.[26‑32]
The success of his fellows was a
source of great delight and pride to him.
In 2010, the IATCVS bestowed on him the great honor
of “Life‑time achievement” award, a sweet complement
to his 2005 “Lifetime achievement” awarded by the
Paediatric Cardiac Society of India: a long‑deserved
acknowledgment of his important contributions to
neonatal cardiac surgery. He was recognized as a giant in
his specialty. His career spanning more than four decades
and extending to multiple countries and his pioneering
contributions, against all odds, towards the development
of pediatric cardiac surgery graced him with the title of:
“A Father of Paediatric Cardiac Surgery in India.”
Finally at peace with himself, IM Rao humbly reminisces
often about his career with amazement and gratitude. He
often quotes his greatest hero, Walton Lillehei: “Some see
things as they are and ask why change? Others dream
of things that never were and ask why not? Change
comes because someone somewhere has the courage of
conviction‑no matter how foolish.”
Acknowledgement
My profuse thanks go to Professors Iyer, Dharmapuram,
Nazer, Balram, Sharma, Cherian, Meera Rao and
many others for their invaluable time, kindness and
encouragement. My sincere gratitude to my brother
for being such an inspiration in my academic surgical
career!.
Financial support and sponsorship
Nil.
Conflict of interest
This is a story about my eldest brother and his many
contributions to the evolution of neonatal cardiac
surgery in India and the Middle East. He was a real
pioneer and a great inspiration to his students and
fellows. We spent time together in AMC and AIIMS and I
had first‑hand information on that part of his life. Beyond
that, I relied on his own accounts and my conversations
with many of his peers and students. I made a sincere
attempt to present factual information. I cannot be
absolutely certain, however, that an occasional personal
perspective did not creep in.
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